PBM, Inc.
10330 Hickman Mills Dr.
Building 2
Kansas City
MO 64137
Ph: 816.501.5138
Fax: 816.777.0626
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Dealing with problem behaviors...
ICT
services are designed to decrease problem behavior and increase
instruction following by teaching and training parents, teachers,
and professionals how to effectively use behavioral procedures
when working with persons with challenging behavior.
Though
the focus of our ICT services appears to be somewhat narrow (especially
given the spectrum of behavioral issues many of our clients are
facing), we concentrate on reducing problem behavior and teaching
instruction following for several important reasons:
-
Problem
behavior interrupts the daily lives of our clients.
-
When
children stop engaging in problem behavior and start to follow
instructions, parents, family members, teachers, etc. can begin
to teach new skills - increasing the quality of life for all
involved.
-
Problem
behavior often has a well-established history of reinforcement,
as a result, reducing problem behavior and teaching instruction
following can require intensive intervention.
-
ICT
staff are specifically trained to identify commonly overlooked
variables that function to cause, contribute to, and maintain
problem behavior.
We
aim to develop procedures that can be used by parents, family
members, teachers, and professionals - Ultimately, we want the
careproviders we work with to be the agents of behavior change
and to become as adept at using the support procedures as our
ICT staff.
What
does an ICT intervention look like?
Before
beginning an intervention, an important foundation must be established.
Our ICT team members will first observe the problem behavior occurring
in the natural environment (e.g., home, school, workshop, etc.).
We make these observations because written descriptions and the
many evaluations often do not convey exactly what is happening
in the real environment. Following these observations we also
require that at least the primary care providers (i.e., usually
the parents), and as many other interested persons (e.g., teachers,
extended family, etc.) attend a 3 to 5 hour training seminar.
During this seminar we discuss the approach on which our interventions
are based, provide our clients with some of the rationales as
to why we do what we do, and discuss the results of our observations.
When
we begin an intervention, we first set up the physical environment
to maximize positive behavior and minimize undesirable behavior.
We may ask that certain items in the house or classroom be rearranged.
For example, we may provide specialized equipment that allows
only mom and dad to control when the TV, computer, Nintendo, etc.,
is on. Initially, depending on the environments in which we are
asked to provide services, ICT staff will briefly work one on
one with the child to build rapport, establish the new "rules"
and to begin teaching appropriate behaviors to replace old undesirable
behavior.
As
we establish instruction following and have the full support plan
in place, ICT staff begin to fade in the family members, teachers,
etc. to implement portions of the support plan. When the family,
teachers, etc. are able to consistently implement the support
plan, ICT staff gradually reduce assistance until our role is
on a consultation basis only.
Interestingly,
unlike a medical model of service provision in which the majority
of recourses are allocated to treating the child, the ICT service
model is to actually allocate 90% of our time teaching mom and
dad (and other interested persons) how to manage problem behavior
and increase instruction following, and 10% of our total time
working specifically with the child.
In
fact, PBM, Inc. is a teaching and training organization for behavioral
approaches to managing behavior and teaching new skills - we do
not consider ourselves as a direct care service provider.
Though
a small number of families utilize ICT on an as needed consultation
basis, for many of our ICT clients service provision is indeed
"intensive." Because problem behavior does not happen
between 8am and 5pm, ICT consultants provide services at any time
of the day or night. Further, at least initially, ICT consultants
may spend many hours each day in the home, school, and wherever
else we are needed. This is because it is far easier and significantly
more effective to teach parents on how to follow our recommendations
as an individual engages in problem behavior. Further, research
clearly shows that when the variables causing, maintaining, and
contributing to problem behavior are changed, as happens during
an ICT intervention, the problem behavior is likely to get worse
before it gets better. Our experience has taught us that if we
are not available during this period of escalation, our chances
of success are reduced.
Accordingly,
the criterion for when ICT fades out from providing assistance
is not necessarily dependent on the behavior of the child. Though
we never fade out of a family in crisis, ICT staff look at whether
mom, dad, and whomever else is involved in the intervention can
implement the support plan consistently to determine when we begin
fading support. This decision, however, is made with our clients,
and our involvement in a consultative role to help troubleshoot
and adjust the support plan remains an ongoing relationship.
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